L20: Retraining High Level Mobility Flashcards
What are 5 examples of high level mobility?
What are the 9 abilities that are available when you have higher level mobility?
- Avoid dangerous situations
- Take a quicker step to prevent falls
- Walk faster – cross roads, keep up with family/peers
- Easier community access
- Eg. not enough railings
- Playing with/caring for children
- Promoting fitness/weight management –> general self-esteem (being able to work up to the level that is beneficial)
- Participation in leisure, social, sporting activity
- Social connectedness
- Self esteem and emotional well-being
- Trauma, grieving period has past but still has a large emotional aspect
= quality of life
What are the 5 current research on TBI as rationale for education? What is the effect of improved health care responses?
- TBI population is 1 in 1000, 70% male, 75% less than 25 years of age
- 98% of TBI patients walk independently at 2 years, 60% unable to jump or run
- Get to a point where they are mobile –> need to thjnk about how hey can further challenge these patients (high mobility skills)
- As little as 7% of stroke patients return to normal gait speeds
- 85% never return to pre-morbid leisure or sporting activity
- Massive impact of CV fitness, mental health
- 20% admitted to hospital with moderate/severe TBI compared to 80% with mild TBI
- Severe enough but not severe enough that these functional tasks are impossible
Improved health care responses… challenging therapists to achieve QOL for greater numbers (post accident, from birth, with various conditions)
- Eg. imaging, surgery –> more successful
- Larger client base –> maximise QoL
What are 5 barriers to increased Quality of Life from a health practitioners perspective?
- Funding and discharge pressures
- Acceptance by patient/therapist that walking is a good outcome
- It is but shouldn’t stop there (therapist should not accept when enough is enough or successful)
- Lack of skill to progress patients
- Limited (but emerging) evidence to educate & guide therapists…
- Opportunity –> as educators/enablers –> NDIS
What are 3 barriers to increased Quality of Life from a patient’s perspective?
- Cost, lack of accessible facilities & transportation/environmental factors,
- Eg. driving is a challenge –> should work on higher mobility skills)
- People who engaged in physical activity prior to injury were more motivated to have these goals
- Only very small minority of patients suggest physical impairments are the barrier (loss of social support, fatigue from long rehab processes etc)
- Access and funding
What are the 2 mobility continuums?
In the bed mobility to running mobility continuum, where can high level mobility be added and what is trained?
What are the 10 progressions of high level mobility from walking to skipping (reciprocal hopping)?
What are 3 characteristics in the biomechanics of walking?
- Is a double support phase and no flight phase
- 2 legs on ground at any time
- Always in contact with ground
- Around 60% of gait cycle is stance phase
- On one leg (quite stable)
- Initial foot contact should be heel strike
- Start posteriorly
What are 5 characteristics in the biomechanics of running?
- Transition from walking to running 2.0 to 2.7m/s (6.5km/hr – 8.5km/hr)
- Increase cadence (frequency) and take longer steps
- No double support phase, ie, apparent flight phase (happens twice during cycle, once at beginning of swing and once at end of swing)
- Proportionally greater swing phase (dependent on speed but 60% - 70% of cycle swing phase)
- Primary shock absorber is quads- On landing
- Debate about optimal initial contact – heel strike vs midfoot vs forefoot
- Typically moving further forward in foot
What are 3 characteristics in the biomechanics of sprinting
- Initial contact with forefoot
- Elite sprinter – 80-90% of cycle is in swing phase
- Primary shock absorber is calves
What are the 4 key points in the 100m world record for sprinting?
- Powerful
- Flight phase
- Don’t get as much stability with the ground
- Increase stride length
- Increase stride frequency
What is the swing versus stance phase for walking and running?
What are 2 strategies for increasing speed in gait (walking/running)?
- Pushing on the ground more forcefully (power)
- Which helps increase stride length
- Pushing on the ground more frequently (cadence)
- Moving feet quicker
Combination of both
- Can’t take lots of quick steps
- Can’t just take excessive long steps
- Eg. increase stride length but slowing down = more stable and faster
- OR
- Decrease stride lenegth but getting faster = more stable and faster
What are 3 biomechanics of the hip in walking and running?
- Double the amount of hip flexion is required in running compared with walking- Increase mvt of hip flexor
- Propulsion from hip flexors after toe off is one of the most critical power generators as speed increases
- Increased proximal power allows increased stride frequency (strategy 2)
What are 3 biomechanics of the knee in walking and running?
- Note more knee flexion in running to allow for more clearance in swing
- Increased knee flexion shortens the lever and allows the knee the get through faster and get the foot to the ground for contact faster (strategy 2)
- Increase cadence
- Hamstrings decelerate as the knee extends
What are 3 biomechanics of the ankle in walking and running?
-
DF more important for walking
- Spring leaf AFO for foo clearance = in DF (so can still get PF)
-
PF responsible for greater force generation off ground (strategy 1)
- Getting foot clearance at the knee (shortened lever)
- Training PF more in running than walking
- Critical component of increasing stride length and therefore speed of walking, jogging, running
What does the HiMAT Assessment Tool Look like?
